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Meşe S, Harmancı P. Examining the Relationship Between Healthy Life Awareness and Psychological Well-Being in Liver Transplantation Patients: A Structural Equation Model. Nurs Health Sci 2025; 27:e70061. [PMID: 39914803 PMCID: PMC11802265 DOI: 10.1111/nhs.70061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Revised: 01/24/2025] [Accepted: 01/25/2025] [Indexed: 02/11/2025]
Abstract
This study aimed to evaluate the mediating role of healthy life awareness in the relationship between the sociodemographic characteristics and psychological well-being of liver transplant patients. The sample of the study consisted of 202 patients aged between 18 and 69 years who underwent liver transplantation surgery at a hospital in Turkey. The data were collected using a sociodemographic information form, the "Healthy Life Awareness Scale" and the "Psychological Well-Being Scale." Healthy life awareness directly predicted psychological well-being (β: 0.68, p < 0.01). Education positively predicted psychological well-being both directly (β: 0.14, p < 0.05) and indirectly through healthy life awareness (β: 0.76, p < 0.05). Age indirectly predicted healthy life awareness and psychological well-being through employment status and education. The income level positively predicted healthy life awareness (β: 0.14, p < 0.05), whereas gender (male) negatively predicted healthy life awareness (β: -0.22, p < 0.01). Healthy life awareness was a significant predictor of psychological well-being. The results of this study may offer valuable information for healthcare providers to tailor interventions that also support mental and emotional health, which is critical to the long-term success of transplant outcomes.
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Affiliation(s)
- Sevinç Meşe
- Faculty of Health Sciences, Department of NursingKahramanmaraş İstiklal UniversityKahramanmarasTurkey
| | - Pınar Harmancı
- Faculty of Health Sciences, Department of NursingKahramanmaraş İstiklal UniversityKahramanmarasTurkey
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Cordoba-Alvarado R, Romero-Fonnegra V, Cortes-Mejia N, Bejarano-Ramirez DF, Maldonado-Hoyos V, Sanchez-Garcia SJ, Vera-Torres A. Quality of life, anxiety, and depression improve at one-year after liver transplantation in patients with advanced liver disease. FRONTIERS IN TRANSPLANTATION 2024; 3:1476952. [PMID: 39640493 PMCID: PMC11617532 DOI: 10.3389/frtra.2024.1476952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 10/28/2024] [Indexed: 12/07/2024]
Abstract
Background Liver transplantation (LT) improves survival in end-stage liver disease. Several reports have addressed the impact of LT on patients' lives, beyond purely medical outcomes. Although the quality of life and mental health have been demonstrated to improve with this procedure, such studies are still missing in Latin America. Methods Patients who received LT at the Fundación Santa Fe de Bogotá between 2017 and 2019 were assessed for quality of life (QoL), anxiety, and depression and they were followed up for one year after the procedure. Pre-transplant data were gathered at inclusion on the waiting list, while post-transplant data at 3- and 12 months after LT. European Quality of Life-5 Dimensions (EQ-5D) and European Quality of Life-Visual Analog Scale (EQ-VAS) instruments were used to evaluate QoL. The Hospital Anxiety and Depression Scale (HADS) was used for evaluating anxious and depressive symptoms. Results 115 recipients met the inclusion criteria. Mean pre-transplant EQ-VAS was 70.78, rising to 87.16 and 92.56 at 3- and 12-months, respectively. Improvements in all EQ-5D dimensions were found in response to LT. According to the HADS questionnaire, anxiety was reduced by 2.35 points and depression by 1.63 points after LT. Conclusion in the short term, LT is a successful strategy for enhancing QoL, anxiety, and depression in patients with liver disease. Long-term benefits must be assessed.
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Affiliation(s)
- Rosana Cordoba-Alvarado
- Clinical Psychology Section, Transplant Services, Fundacion Santa Fe de Bogotá, Bogotá, Colombia
- Transplant and Hepatobiliary Surgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | | | - Nicolas Cortes-Mejia
- Transplant and Hepatobiliary Surgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Division of Anesthesiology Critical Care Medicine, and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Diana Fernanda Bejarano-Ramirez
- Transplant and Hepatobiliary Surgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Epidemiology and Biostatistics Group, Graduate School, Universidad CES, Medellín, Colombia
| | | | | | - Alonso Vera-Torres
- Transplant and Hepatobiliary Surgery Department, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia
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Campillo Amo N, Martínez EP, Gomis AVDH, Ramírez ACL, Román CJVDH. An Analysis of the Influence of a Patient's Sex on Quality of Life in Liver and Kidney Transplantation. Healthcare (Basel) 2024; 12:2116. [PMID: 39517329 PMCID: PMC11544880 DOI: 10.3390/healthcare12212116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Revised: 10/21/2024] [Accepted: 10/23/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Renal and liver transplantation influences the quality of life of the patients who undergo these procedures. Therefore, the aim of the present study was to analyze possible differences in liver and kidney transplantation in relation to the patient's sex and to determine their impact on quality of life. METHODOLOGY An observational study was carried out with 147 patients with liver (n = 70) and kidney (n = 77) failure on the transplantation waiting list. The possible influence of sex on clinical, sociodemographic, and psychological aspects of the patients' quality of life before and 6 months after transplantation was analyzed. Questionnaires on health-related quality of life (SF-36), the perception of social and family support (EASP), and coping strategies (CEA), the depression and anxiety scale (HAD), and the Eysenck personality inventory (EPI) were used. A univariate analysis was performed according to sex using statistical tools including the Chi-square test, the t-test, and a univariate linear analysis of variance. RESULTS In patients on the waiting list for liver transplantation, we found sex differences in terms of age (p = 0.040), time of evolution of end-stage liver disease (p = 0.013), etiology (p = 0.07), and associated complications, as well as in the consumption of tobacco and other psychotropic substances (p = 0.022), while patients on the waiting list for renal transplantation showed sex-related differences in terms of etiology (p = 0.012) and alcohol consumption (p = 0.005). The results showed significant sex-related differences in sociodemographic and psychological aspects, but no significant sex-related differences were observed in global quality of life in either of the two assessments in both groups. DISCUSSION The findings suggest that improvement in quality of life after liver or kidney transplantation is not influenced by the patient's sex.
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Affiliation(s)
- Naiara Campillo Amo
- Departamento de Medicina Clínica, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain; (N.C.A.); (E.P.M.)
| | - Enrique Pérez Martínez
- Departamento de Medicina Clínica, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain; (N.C.A.); (E.P.M.)
- Servicio de Psiquiatría, Hospital General Universitario Dr. Balmis, 03010 Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain;
| | | | - Ana Carolina Londoño Ramírez
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain;
- Departamento de Farmacología, Pediatría y Química Orgánica, Universidad Miguel Hernández (UMH), 03550 Alicante, Spain
- Servicio de Farmacología Clínica, Hospital General Universitario Dr. Balmis, 03010 Alicante, Spain
| | - Carlos J. van-der Hofstadt Román
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain;
- Departamento de Psicología de la Salud, Universidad Miguel Hernández (UMH), 03202 Alicante, Spain
- Unidad de Psicología Hospitalaria, Hospital General Universitario Dr. Balmis, 03010 Alicante, Spain
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Fuochi E, Anastasio L, Lynch EN, Campani C, Dragoni G, Milani S, Galli A, Innocenti T. Main factors influencing long-term outcomes of liver transplantation in 2022. World J Hepatol 2023; 15:321-352. [PMID: 37034235 PMCID: PMC10075010 DOI: 10.4254/wjh.v15.i3.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/24/2022] [Accepted: 02/22/2023] [Indexed: 04/11/2023] Open
Abstract
Liver transplant (LT) outcomes have markedly improved in the recent decades, even if long-term morbidity and mortality are still considerable. Most of late deaths are independent from graft function and different comorbidities, including complications of metabolic syndrome and de novo neoplasms, seem to play a key role in determining long-term outcomes in LT recipients. This review discusses the main factors associated with late mortality and suggests possible strategies to improve long-term management and follow-up after liver transplantation. In particular, the reduction of drug toxicity, the use of tools to identify high-risk patients, and setting up a multidisciplinary team also for long-term management of LT recipients may further improve survival after liver transplantation.
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Affiliation(s)
- Elisa Fuochi
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Lorenzo Anastasio
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Erica Nicola Lynch
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Claudia Campani
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Gabriele Dragoni
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
- Department of Medical Biotechnologies, University of Siena, Siena 53100, Italy
| | - Stefano Milani
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Andrea Galli
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
| | - Tommaso Innocenti
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence 50134, Italy
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Singh N, Watt KD, Bhanji RA. The fundamentals of sex-based disparity in liver transplantation: Understanding can lead to change. Liver Transpl 2022; 28:1367-1375. [PMID: 35289056 DOI: 10.1002/lt.26456] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 02/21/2022] [Accepted: 03/09/2022] [Indexed: 01/13/2023]
Abstract
Liver transplantation (LT) is the definitive treatment for end-stage liver disease. Unfortunately, women are disadvantaged at every stage of the LT process. We conducted a literature review to increase the understanding of this disparity. Hormonal differences, psychological factors, and Model for End-Stage Liver Disease (MELD) score inequalities are some pretransplantation factors that contribute to this disparity. In the posttransplantation setting, women have differing risk than men in most major outcomes (perioperative complications, rejection, long-term renal dysfunction, and malignancy) and assessing the two groups together is disadvantageous. Herein, we propose interventions including standardized criteria for LT referral, using an alternate MELD, education for support of women, and motivating women to seek living donors. Understanding sex-based differences will allow us to improve access, tailor management, and improve overall outcomes for all patients, particularly women.
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Affiliation(s)
- Noreen Singh
- Division of Gastroenterology (Liver Unit), University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Kymberly D Watt
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rahima A Bhanji
- Division of Gastroenterology (Liver Unit), University of Alberta Hospital, Edmonton, Alberta, Canada
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Cristin DJ, Forman LM, Jackson WE. Beyond Survival: Targeting Health-Related Quality of Life Outcomes After Liver Transplantation. Clin Liver Dis (Hoboken) 2021; 17:359-364. [PMID: 34136142 PMCID: PMC8177828 DOI: 10.1002/cld.1059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/14/2020] [Accepted: 10/25/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- David J. Cristin
- Division of Gastroenterology and HepatologyUniversity of Colorado Anschutz Medical CenterAuroraCO
| | - Lisa M. Forman
- Division of Gastroenterology and HepatologyUniversity of Colorado Anschutz Medical CenterAuroraCO
| | - Whitney E. Jackson
- Division of Gastroenterology and HepatologyUniversity of Colorado Anschutz Medical CenterAuroraCO
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Factors Affecting Quality of Life in Liver Transplant Candidates: An Observational Study. TRANSPLANTOLOGY 2021. [DOI: 10.3390/transplantology2010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Health-related quality of life (HRQOL) before and after liver transplant (LT) is an important outcome in LT candidates as, in these patients, HRQOL is commonly impaired. However, evidence regarding factors that influence HRQOL in patients with end-stage liver disease is inconclusive. The aim of the present study was to identify factors associated with poor HRQOL. An observational study was conducted over LT candidates. The 36-item Short Form Health Survey (widely used to assess HRQOL) and the Hospital Anxiety and Depression Scale were administered to 211 patients during the pre-transplant assessment. Baseline demographic and clinical data were also collected. Multiple regression analysis was performed to investigate risk factors for poor HRQOL. Female sex (lower B = 7.99 95%C = 0.07–15.92, higher B = 18.09 95%CI = 7.56–28.62), encephalopathy (lower B = −9.45, 95%CI = −14.59–−4.31, higher B = −6.69, 95%CI = −13.13 to −0.25), higher MELD scores (lower B = −1.14, 95%CI = −1.67 to −0.61, higher B = −0.33, 95%CI = −0.65 to −0.12), anxiety (lower B = −3.04 95%C = −4.71 to −1.36, higher B = −1.93 95%CI = −3.39 to −0.47)and depression (lower B = −3.27 95%C = −4.46 to −2.08, higher B = −1.02 95%CI = −1.90 to −0.13) symptoms were associated to poorer HRQOL. Psychosocial interventions should be addressed to liver transplant candidates, especially to women, patients with anxiety, depression or episodes of encephalopathy, in order to prevent the impact that these conditions can have on HRQOL.
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8
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Dąbrowska-Bender M, Kozaczuk A, Pączek L, Milkiewicz P, Słoniewski R, Staniszewska A. Patient Quality of Life After Liver Transplantation in Terms of Emotional Problems and the Impact of Sociodemographic Factors. Transplant Proc 2018; 50:2031-2038. [PMID: 30177104 DOI: 10.1016/j.transproceed.2018.03.113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/15/2018] [Accepted: 03/23/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Liver transplantation is recognized as an effective and necessary treatment of chronic as well as acute hepatic failure. The assessment of quality of life (QoL) after transplantation represents an ancillary tool to evaluate the efficacy of solid organ transplantation in addition to graft and patient survival rates and complications. The global assessment of QoL after transplantation usually confirms improvement compared to pretransplant conditions. PURPOSE An attempt to evaluate the quality of life of patients after liver transplantation, with particular reference to sociodemographic factors and emotional problems. MATERIALS AND METHODS The study group included 121 patients (55 women and 66 men) at the age of 19 to 71 years who underwent surgery in the Central Teaching Hospital of the Medical University of Warsaw and the Infant Jesus Teaching Hospital in Warsaw, and were subsequently treated in an outpatient transplant clinic. The scoring procedure for the areas analyzed was based on the 36-Item Short Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). RESULTS Higher patients age was correlated with lower quality of life of patients after liver transplantation, including physical functioning (patients >40 years of age declared lower physical performance, and patients <30 years of age indicated greatest limitations in their kind of work or other activities). The frequency of pain was also age-dependent (mostly patients >50 years of age). Women more often than men had worrying thoughts, were feeling tense or wound up, and had sudden feelings of anxiety or panic. By contrast, older people often declared that they felt to be slowed down. CONCLUSIONS To reduce pain and to improve physical performance of the study patients, rehabilitation procedures should be considered. Patients indicating symptoms associated with anxiety and depression should be referred to a clinical psychologist.
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Affiliation(s)
- M Dąbrowska-Bender
- Department of Clinical Dietetics, Medical University of Warsaw, Warsaw, Poland.
| | - A Kozaczuk
- Medical University of Warsaw, Warsaw, Poland
| | - L Pączek
- Department of Immunology, Transplant Medicine and Internal Diseases, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland
| | - P Milkiewicz
- Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - R Słoniewski
- Department of Public Health, Medical University of Warsaw, Warsaw, Poland
| | - A Staniszewska
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
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Garcia CS, Lima AS, La-Rotta EIG, Boin IDFSF. Social support for patients undergoing liver transplantation in a Public University Hospital. Health Qual Life Outcomes 2018; 16:35. [PMID: 29454342 PMCID: PMC5816372 DOI: 10.1186/s12955-018-0863-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 02/07/2018] [Indexed: 01/16/2023] Open
Abstract
Background Several diseases may lead to the need for liver transplantation due to progressive organ damage until the onset of cirrhosis, resulting in changes in interpersonal relationships. Social Support for transplant candidates is an important variable, providing them with psychological and social well-being. This study aims to assess social support in chronic hepatic patients, waiting for liver transplantation. Methods A cross-sectional study was conducted with 119 patients, for convenience sampling, from the liver transplant waiting list at a Brazilian University Hospital Outpatients. The information was collected through semistructured questionnaires, in four stages: 1) socioeconomic and demographic information 2) clinical aspects 3) feelings 4) Social Support Network Inventory (SSNI), to Brazilian Portuguese. The statistical analysis was conducted using ANOVA and multivariate linear regression analysis to evaluate the relationship between the scales of social support and the collected co-variables. Results Average age was 50.2 ± 11.6, and 87 (73.1%) were men. Patients with alcohol and virus liver disease etiology had the same frequency of 28%. The MELD, without extrapoints, was 16.7 ± 4.9. Global social support family score was 3.72 ± 0.39, and Cronbach’s alpha = 0.79. The multivariate analysis presented the following associations, age = [− 0.010 (95% CI = − 0.010 - -0.010); P = 0.001], etiology of hepatic disease = [− 0.212 (95% CI = − 0.37 - -0.05); P = 0.009], happiness = [− 0.214(95% CI = − 0.33 - -0.09) P = 0.001) and aggressiveness = [0.172 (95% CI = 0.040–0.030); P = 0.010). Conclusions The social support was greater when the patients were younger (18 to 30 years). Patients with alcoholic cirrhosis, regardless of whether or not they were associated with virus, had less social support. As for feelings, the absence of happiness and the presence of aggressiveness showed a negative effect on social support.
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Affiliation(s)
- Clerison Stelvio Garcia
- Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil. .,Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil.
| | - Agnaldo Soares Lima
- Faculty of Medicine - Federal University of Minas Gerais - Unit of Liver Transplantation at the Alpha Institute Gastroenterology Department, Belo Horizonte, Brazil
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Pflugrad H, Tryc AB, Goldbecker A, Strassburg CP, Barg-Hock H, Klempnauer J, Weissenborn K. Hepatic encephalopathy before and neurological complications after liver transplantation have no impact on the employment status 1 year after transplantation. World J Hepatol 2017; 9:519-532. [PMID: 28443157 PMCID: PMC5387364 DOI: 10.4254/wjh.v9.i10.519] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/23/2017] [Accepted: 03/12/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the impact of hepatic encephalopathy before orthotopic liver transplantation (OLT) and neurological complications after OLT on employment after OLT. METHODS One hundred and fourteen patients with chronic liver disease aged 18-60 years underwent neurological examination to identify neurological complications, neuropsychological tests comprising the PSE-Syndrome-Test yielding the psychometric hepatic encephalopathy score, the critical flicker frequency and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), completed a questionnaire concerning their occupation and filled in the short form 36 (SF-36) to assess health-related quality of life before OLT and 12 mo after OLT, if possible. Sixty-eight (59.6%) patients were recruited before OLT, while on the waiting list for OLT at Hannover Medical School [age: 48.7 ± 10.2 years, 45 (66.2%) male], and 46 (40.4%) patients were included directly after OLT. RESULTS Before OLT 43.0% of the patients were employed. The patients not employed before OLT were more often non-academics (employed: Academic/non-academic 16 (34.0%)/31 vs not employed 10 (17.6%)/52, P = 0.04), had more frequently a history of hepatic encephalopathy (HE) (yes/no; employed 15 (30.6%)/34 vs not employed 32 (49.2%)/33, P = 0.05) and achieved worse results in psychometric tests (RBANS sum score mean ± SD employed 472.1 ± 44.5 vs not employed 443.1 ± 56.7, P = 0.04) than those employed. Ten patients (18.2%), who were not employed before OLT, resumed work afterwards. The patients employed after OLT were younger [age median (range, min-max) employed 47 (42, 18-60) vs not employed 50 (31, 29-60), P = 0.01], achieved better results in the psychometric tests (RBANS sum score mean ± SD employed 490.7 ± 48.2 vs not employed 461.0 ± 54.5, P = 0.02) and had a higher health-related quality of life (SF 36 sum score mean ± SD employed 627.0 ± 138.1 vs not employed 433.7 ± 160.8; P < 0.001) compared to patients not employed after OLT. Employment before OLT (P < 0.001), age (P < 0.01) and SF-36 sum score 12 mo after OLT (P < 0.01) but not HE before OLT or neurological complications after OLT were independent predictors of the employment status after OLT. CONCLUSION HE before and neurological complications after OLT have no impact on the employment status 12 mo after OLT. Instead younger age and employment before OLT predict employment one year after OLT.
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Affiliation(s)
- Henning Pflugrad
- Henning Pflugrad, Anita B Tryc, Annemarie Goldbecker, Karin Weissenborn, Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Anita B Tryc
- Henning Pflugrad, Anita B Tryc, Annemarie Goldbecker, Karin Weissenborn, Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Annemarie Goldbecker
- Henning Pflugrad, Anita B Tryc, Annemarie Goldbecker, Karin Weissenborn, Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Christian P Strassburg
- Henning Pflugrad, Anita B Tryc, Annemarie Goldbecker, Karin Weissenborn, Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Hannelore Barg-Hock
- Henning Pflugrad, Anita B Tryc, Annemarie Goldbecker, Karin Weissenborn, Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Jürgen Klempnauer
- Henning Pflugrad, Anita B Tryc, Annemarie Goldbecker, Karin Weissenborn, Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
| | - Karin Weissenborn
- Henning Pflugrad, Anita B Tryc, Annemarie Goldbecker, Karin Weissenborn, Department of Neurology, Hannover Medical School, 30625 Hannover, Germany
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Karacaer Z, Cakir B, Erdem H, Ugurlu K, Durmus G, Ince NK, Ozturk C, Hasbun R, Batirel A, Yilmaz EM, Bozkurt I, Sunbul M, Aynioglu A, Atilla A, Erbay A, Inci A, Kader C, Tigen ET, Karaahmetoglu G, Coskuner SA, Dik E, Tarakci H, Tosun S, Korkmaz F, Kolgelier S, Karadag FY, Erol S, Turker K, Necan C, Sahin AM, Ergen P, Iskender G, Korkmaz P, Eroglu EG, Durdu Y, Ulug M, Deniz SS, Koc F, Alpat SN, Oztoprak N, Evirgen O, Sozen H, Dogan M, Kaya S, Kaya S, Altindis M, Aslan E, Tekin R, Sezer BE, Ozdemir K, Ersoz G, Sahin A, Celik I, Aydin E, Bastug A, Harman R, Ozkaya HD, Parlak E, Yavuz I, Sacar S, Comoglu S, Yenilmez E, Sirmatel F, Balkan II, Alpay Y, Hatipoglu M, Denk A, Senol G, Bitirgen M, Geyik MF, Guner R, Kadanali A, Karakas A, Namiduru M, Udurgucu H, Boluktas RP, Karagoz E, Ormeci N. Quality of life and related factors among chronic hepatitis B-infected patients: a multi-center study, Turkey. Health Qual Life Outcomes 2016; 14:153. [PMID: 27809934 PMCID: PMC5095975 DOI: 10.1186/s12955-016-0557-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 10/21/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The aim of this study was to assess health-related quality of life (HRQOL) among chronic hepatitis B (CHB) patients in Turkey and to study related factors. METHODS This multicenter study was carried out between January 01 and April 15, 2015 in Turkey in 57 centers. Adults were enrolled and studied in three groups. Group 1: Inactive HBsAg carriers, Group 2: CHB patients receiving antiviral therapy, Group 3: CHB patients who were neither receiving antiviral therapy nor were inactive HBsAg carriers. Study data was collected by face-to-face interviews using a standardized questionnaire, Short Form-36 (SF-36) and Hepatitis B Quality of Life (HBQOL). Values equivalent to p < 0.05 in analyses were accepted as statistically significant. RESULTS Four thousand two hundred fifty-seven patients with CHB were included in the study. Two thousand five hundred fifty-nine (60.1 %) of the patients were males. Groups 1, 2 and 3, consisted of 1529 (35.9 %), 1721 (40.4 %) and 1007 (23.7 %) patients, respectively. The highest value of HRQOL was found in inactive HBsAg carriers. We found that total HBQOL score increased when antiviral treatment was used. However, HRQOL of CHB patients varied according to their socio-demographic properties. Regarding total HBQOL score, a higher significant level of HRQOL was determined in inactive HBV patients when matched controls with the associated factors were provided. CONCLUSIONS The HRQOL score of CHB patients was higher than expected and it can be worsen when the disease becomes active. Use of an antiviral therapy can contribute to increasing HRQOL of patients.
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Affiliation(s)
- Zehra Karacaer
- Department of Infectious Diseases and Clinical Microbiology, Etimesgut Military Hospital, Ankara, Turkey
| | - Banu Cakir
- Institute of Public Health, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hakan Erdem
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Military Medical Academy, Ankara, Turkey
| | - Kenan Ugurlu
- Department of Infectious Diseases and Clinical Microbiology, 25 Aralık State Hospital, Gaziantep, Turkey
| | - Gul Durmus
- Department of Infectious Diseases and Clinical Microbiology, Sevket Yilmaz Training and Research Hospital, Bursa, Turkey
| | - Nevin Koc Ince
- Department of Infectious Diseases and Clinical Microbiology, Duzce University School of Medicine, Duzce, Turkey
| | - Cinar Ozturk
- Department of Infectious Diseases and Clinical Microbiology, Recep Tayyip Erdogan University School of Medicine, Rize, Turkey
| | - Rodrigo Hasbun
- Department of Infectious Diseases, The University of Texas Health Science Center at Houston, Medical School, Houston, TX USA
| | - Ayse Batirel
- Department of Infectious Diseases and Clinical Microbiology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Istanbul, Turkey
| | - Esmeray Mutlu Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Samsun Training and Research Hospital, Samsun, Turkey
| | - Ilkay Bozkurt
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - Mustafa Sunbul
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - Aynur Aynioglu
- Department of Infectious Diseases and Clinical Microbiology, Ataturk State Hospital, Zonguldak, Turkey
| | - Aynur Atilla
- Department of Infectious Diseases and Clinical Microbiology, Samsun Training and Research Hospital, Samsun, Turkey
| | - Ayse Erbay
- Department of Infectious Diseases and Clinical Microbiology, Bozok University School of Medicine, Yozgat, Turkey
| | - Ayse Inci
- Department of Infectious Diseases and Clinical Microbiology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Cigdem Kader
- Department of Infectious Diseases and Clinical Microbiology, Bozok University School of Medicine, Yozgat, Turkey
| | - Elif Tukenmez Tigen
- Department of Infectious Diseases and Clinical Microbiology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Gokhan Karaahmetoglu
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Military Medical Academy Haydarpasa Training and Research Hospital, Istanbul, Turkey
| | - Seher Ayten Coskuner
- Department of Infectious Diseases and Clinical Microbiology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Ebru Dik
- Department of Infectious Diseases and Clinical Microbiology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Huseyin Tarakci
- Department of Infectious Diseases and Clinical Microbiology, Izmir Metropolitan Municipalities Esrefpasa Hospital, Izmir, Turkey
| | - Selma Tosun
- Department of Infectious Diseases and Clinical Microbiology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Fatime Korkmaz
- Department of Infectious Diseases and Clinical Microbiology, Konya Training and Research Hospital, Konya, Turkey
| | - Servet Kolgelier
- Department of Infectious Diseases and Clinical Microbiology, Yildirim Beyazit University Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Fatma Yilmaz Karadag
- Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Serpil Erol
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Kamuran Turker
- Department of Infectious Diseases and Clinical Microbiology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Ceyda Necan
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Ahmet Melih Sahin
- Department of Infectious Diseases and Clinical Microbiology, Giresun State Hospital, Giresun, Turkey
| | - Pinar Ergen
- Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Gulsen Iskender
- Department of Infectious Diseases and Clinical Microbiology, Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Pinar Korkmaz
- Department of Infectious Diseases and Clinical Microbiology, Dumlupinar University Evliya Celebi Training and Research Hospital, Kutahya, Turkey
| | - Esma Gulesen Eroglu
- Department of Infectious Diseases and Clinical Microbiology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey
| | - Yasemin Durdu
- Department of Infectious Diseases and Clinical Microbiology, Eyup State Hospital, Istanbul, Turkey
| | - Mehmet Ulug
- Department of Infectious Diseases and Clinical Microbiology, Umit Hospital, Eskisehir, Turkey
| | - Suna Secil Deniz
- Department of Infectious Diseases and Clinical Microbiology, Kecioren Training and Research Hospital, Ankara, Turkey
| | - Filiz Koc
- Department of Infectious Diseases and Clinical Microbiology, Kecioren Training and Research Hospital, Ankara, Turkey
| | - Saygın Nayman Alpat
- Department of Infectious Diseases and Clinical Microbiology, Osmangazi University School of Medicine, Eskisehir, Turkey
| | - Nefise Oztoprak
- Department of Infectious Diseases and Clinical Microbiology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Omer Evirgen
- Department of Infectious Diseases and Clinical Microbiology, Mustafa Kemal University School of Medicine, Hatay, Turkey
| | - Hamdi Sozen
- Department of Infectious Diseases and Clinical Microbiology, Sitki Kocman University School of Medicine, Mugla, Turkey
| | - Mustafa Dogan
- Department of Infectious Diseases and Clinical Microbiology, Corlu State Hospital, Tekirdag, Turkey
| | - Selcuk Kaya
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Safak Kaya
- Department of Infectious Diseases and Clinical Microbiology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Mustafa Altindis
- Department of Clinical Microbiology, Sakarya University School of Medicine, Sakarya, Turkey
| | - Emel Aslan
- Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Recep Tekin
- Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - Busra Ergut Sezer
- Department of Infectious Diseases and Clinical Microbiology, Corlu State Hospital, Tekirdag, Turkey
| | - Kevser Ozdemir
- Department of Infectious Diseases and Clinical Microbiology, Denizli State Hospital, Denizli, Turkey
| | - Gulden Ersoz
- Department of Infectious Diseases and Clinical Microbiology, Mersin University School of Medicine, Mersin, Turkey
| | - Ahmet Sahin
- Department of Infectious Diseases and Clinical Microbiology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Ilhami Celik
- Department of Infectious Diseases and Clinical Microbiology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Emsal Aydin
- Department of Infectious Diseases and Clinical Microbiology, Kafkas University School of Medicine, Kars, Turkey
| | - Aliye Bastug
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Rezan Harman
- Department of Infectious Diseases and Clinical Microbiology, Sani Konukoglu Hospital, Gaziantep, Turkey
| | - Hacer Deniz Ozkaya
- Department of Infectious Diseases and Clinical Microbiology, Karsıkaya State Hospital, Izmir, Turkey
| | - Emine Parlak
- Department of Infectious Diseases and Clinical Microbiology, Ataturk University School of Medicine, Erzurum, Turkey
| | - Ilknur Yavuz
- Department of Infectious Diseases and Clinical Microbiology, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Suzan Sacar
- Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University School of Medicine, Canakkale, Turkey
| | - Senol Comoglu
- Department of Infectious Diseases and Clinical Microbiology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Ercan Yenilmez
- Department of Infectious Diseases and Clinical Microbiology, Kasimpasa Military Hospital, Istanbul, Turkey
| | - Fatma Sirmatel
- Department of Infectious Diseases and Clinical Microbiology, Abant Izzet Baysal University School of Medicine, Bolu, Turkey
| | - Ilker Inanc Balkan
- Department of Infectious Diseases and Clinical Microbiology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Yesim Alpay
- Department of Infectious Diseases and Clinical Microbiology, Balikesir University School of Medicine, Balikesir, Turkey
| | - Mustafa Hatipoglu
- Department of Infectious Diseases and Clinical Microbiology, Canakkale Military Hospital, Canakkale, Turkey
| | - Affan Denk
- Department of Infectious Diseases and Clinical Microbiology, Firat University School of Medicine, Elazig, Turkey
| | - Gunes Senol
- Department of Infectious Diseases and Clinical Microbiology, Izmir Dr. Suat Seren Pulmonology and Pulmonary Surgery Training and Research Hospital, Izmir, Turkey
| | - Mehmet Bitirgen
- Department of Infectious Diseases and Clinical Microbiology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey
| | - Mehmet Faruk Geyik
- Department of Infectious Diseases and Clinical Microbiology, Duzce University School of Medicine, Duzce, Turkey
| | - Rahmet Guner
- Department of Infectious Diseases and Clinical Microbiology, Yildirim Beyazit University Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Ayten Kadanali
- Department of Infectious Diseases and Clinical Microbiology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Karakas
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Military Medical Academy, Ankara, Turkey
| | - Mustafa Namiduru
- Department of Infectious Diseases and Clinical Microbiology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Hatice Udurgucu
- Department of Infectious Diseases and Clinical Microbiology, Firat University School of Medicine, Elazig, Turkey
| | - Rukiye Pinar Boluktas
- Faculty of Health Sciences, Department of Nursing, Selahaddin Eyyubi University, Diyarbakir, Turkey
| | - Ergenekon Karagoz
- Department of Infectious Diseases and Clinical Microbiology, Van Military Hospital, Van, Turkey
| | - Necati Ormeci
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
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Weng LC, Yang YC, Huang HL, Chiang YJ, Tsai YH. Factors that determine self-reported immunosuppressant adherence in kidney transplant recipients: a correlational study. J Adv Nurs 2016; 73:228-239. [DOI: 10.1111/jan.13106] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2016] [Indexed: 01/10/2023]
Affiliation(s)
- Li-Chueh Weng
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
- Department of General Surgery; Chang Gung Medical Foundation-Linkuo; Taoyuan Taiwan
| | - Ya-Chen Yang
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Hsiu-Li Huang
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
- Department of Neurology; Chang Gung Medical Foundation-Linkuo; Taoyuan; Taiwan
| | - Yang-Jen Chiang
- Transplantation Center and Urology Surgery; Chang Gung Medical Foundation-Linkuo Medical Center; Taoyuan Taiwan
| | - Yu-Hsia Tsai
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
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Abstract
Quality of life is an important outcome indicator of experiences associated with liver transplantation. Unfortunately, quality of life has been defined in many different ways, causing confusion and misconceptions among practitioners, researchers, policy makers, and patients. This exploratory qualitative study was initiated to gain greater understanding regarding the adult transplant recipients' experiences with liver transplantation in order to direct future studies with this population and to assist in selection of a relevant quality of life survey tool for quantitative investigation. Twelve informants (7 women, 5 men) shared their experiences in face-to-face interviews conducted by the researcher. Analysis of these interviews reveals the importance of physiologic, psychological, social, spiritual, family, and socioeconomic aspects of quality of life for liver transplant recipients.
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Affiliation(s)
- Kathy B Bean
- University of Texas at Arlington, School of Nursing, Arlington, Tex, USA
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14
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Kelly R, Hurton S, Ayloo S, Cwinn M, De Coutere-Bosse S, Molinari M. Societal reintegration following cadaveric orthotopic liver transplantation. Hepatobiliary Surg Nutr 2016; 5:234-44. [PMID: 27275465 DOI: 10.21037/hbsn.2016.03.04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Studies on patients' societal reintegration following orthotopic liver transplantation (OLT) are scarce. METHODS Between September 2006 and January 2008, all adults who were alive after 3 years post OLT were included in this prospective cohort study. Validated questionnaires were administered to all candidates with the primary aim of investigating the rate of their social re-integration following OLT and potential barriers they might have encountered. RESULTS Among 157 eligible patients 110 (70%) participated. Mean participants' age was 57 years (SD 11.4) and 43% were females. Prior to OLT, 75% of patients were married and 6% were divorced. Following OLT there was no significant difference in marital status. Employment rate fell from 72% to 30% post-OLT. Patients who had been employed in either low-skill or advanced-skill jobs were less likely to return to work. After OLT, personal income fell an average of 4,363 Canadian dollars (CAN$) (SD 20,733) (P=0.03) but the majority of recipients (80%) reported high levels of satisfaction for their role in society. CONCLUSIONS Although patients' satisfaction post-OLT is high, employment status is likely to be negatively affected for individuals who are not self-employed. Strategies to assist recipients in returning to their pre-OLT jobs should be developed to improve patients' economical status and societal ability to recoup resources committed for OLT.
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Affiliation(s)
- Ryan Kelly
- 1 Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada ; 2 Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Scott Hurton
- 1 Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada ; 2 Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Subhashini Ayloo
- 1 Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada ; 2 Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mathew Cwinn
- 1 Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada ; 2 Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sarah De Coutere-Bosse
- 1 Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada ; 2 Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michele Molinari
- 1 Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada ; 2 Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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15
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Dąbrowska-Bender M, Michałowicz B, Pączek L. Assessment of the Quality of Life in Patients After Liver Transplantation as an Important Part of Treatment Results. Transplant Proc 2016; 48:1697-702. [DOI: 10.1016/j.transproceed.2015.12.139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 11/26/2015] [Accepted: 12/30/2015] [Indexed: 10/21/2022]
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17
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The impact of osteoporosis on health-related quality of life in patients after liver transplantation - a pilot study. GASTROENTEROLOGY REVIEW 2016; 10:215-21. [PMID: 26759628 PMCID: PMC4697035 DOI: 10.5114/pg.2015.52343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 12/12/2014] [Accepted: 01/06/2015] [Indexed: 11/17/2022]
Abstract
Introduction Liver transplantation (LT) is now a well-established procedure with 5-year survival rates over 70%, and one of its ultimate goals is the improvement of patient health-related quality of life (HRQOL). Osteoporosis remains a serious potential complication of LT, leading to fragility fractures, pain, and functional impairment. Aim To assess the degree of osteoporosis and the impact of fragility fractures on HRQOL in patients with chronic liver diseases treated with LT. Material and methods Twenty-seven patients (14 female, 13 male) at a median period of 3.5 years post LT participated in the study. HRQOL was assessed by Short Form-36 and PBC-40 instruments. Bone mineral density (BMD) in the lumbar spine and hip neck were measured by dual-energy X-ray absorptiometry. Physical activity was assessed by questionnaire. Data on the duration of the liver disease, time from LT, and fragility fractures were also collected. Results As many as 74.1% of the patients had reduced BMD (t-score < -1.0 SD) in the hip. Mean values of the spine and hip BMD z-scores were -1.1 and -0.9 SD, respectively. Time after LT, percentage of lean tissue, and physical activity were positively associated with BMD. The prevalence of fractures was 48%. We did not find significant differences in age, gender, body composition parameters, physical activity, BMD, and HRQOL scores between the subjects with and without fractures. Conclusions We found a high prevalence of fragility fractures and a decreased BMD in LT recipients. Patients with a history of fractures had similar HRQOL scores to those without fractures.
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Huda A, Newcomer R, Harrington C, Keeffe EB, Esquivel CO. Employment after liver transplantation: a review. Transplant Proc 2015; 47:233-9. [PMID: 25769555 DOI: 10.1016/j.transproceed.2014.10.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 10/27/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Return to productive employment is often an important milestone in the recovery and rehabilitation process after liver transplantation (OLT). This literature review identifies factors associated with employment in patients who underwent OLT. METHODS We searched PubMed for articles that addressed the various factors affecting employment after OLT. RESULTS The studies demonstrated improvement in the quality of life and examined factors that predicted whether patients would return to work after OLT. Demographic variable associated with posttransplant employment included young age, male sex, college degree, Caucasian race, and pretransplant employment. Patients with alcohol-related liver disease had a significantly lower rate of employment than did those with other etiologies of liver disease. Recipients who were employed after transplantation had a significantly better posttransplant functional status than did those who were not employed. CONCLUSION Economic pressures are increasing the expectation that patients who undergo successful OLT will return to work. Thus, transplant teams need to have a better understanding of posttransplant work outcomes for this vulnerable population, and greater attention must be paid to the full social rehabilitation of transplant recipients. Specific interventions for OLT recipients should be designed to evaluate and change their health perceptions and encourage their return to work.
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Affiliation(s)
- A Huda
- Division of Abdominal Transplantation, Department of Medicine, Stanford University Medical Center, Stanford, California; Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Stanford, California.
| | - R Newcomer
- Institute for Health and Aging, University of California, San Francisco, San Francisco, California
| | - C Harrington
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California
| | - E B Keeffe
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Stanford, California
| | - C O Esquivel
- Division of Abdominal Transplantation, Department of Medicine, Stanford University Medical Center, Stanford, California
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Šumskienė J, Kupčinskas L, Šumskas L. Health-related quality of life measurement in chronic liver disease patients. MEDICINA-LITHUANIA 2015; 51:201-8. [PMID: 26424183 DOI: 10.1016/j.medici.2015.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/13/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVE Health-related quality of life (HRQOL) is an important health indicator in medical outcome research and clinical practice. This issue tends to attract even more attention with the recent improvements of patient survival after liver transplantation. This review article aims at providing a deeper insight into practices used for evaluating HRQOL in chronic liver diseases (CLDs) and especially cirrhosis patients during different stages of the disease including liver transplantation. MATERIALS AND METHODS A systematic review of the MEDLINE database and Cochrane library was conducted. A search using the Medical Subject Headings (MeSH) major terms "liver disease" AND "quality of life" was applied for the period from 1966 to 2012. RESULTS Our review identified 1483 publications. The searched showed that significant increase of publications (from 362 to 1018) was observed during last decade (period 2003-2012) in comparison with previous. The majority of publications were in English (n=1179). The literature search and analysis provided information on the most common generic and disease-specific HRQOL instruments, which are used in CLD patients: Medical Outcomes Study Short Form-36, the National Institute of Diabetes and Digestive and Kidney Diseases Quality of Life questionnaire, the Chronic Liver Disease questionnaire, the Liver Disease Quality of Life questionnaire, and other. CONCLUSIONS Quality of life instruments are potentially powerful tools for evaluating the functional status, presenting gains of treatment and reflecting patients' ability to return to a normal lifestyle in CLD patients. More attention should be paid by clinicians for integrated use of clinical tests together with HRQOL instruments in liver transplantation for establishing the reference levels of mental, physical, and role-social functioning.
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Affiliation(s)
- Jolanta Šumskienė
- Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Limas Kupčinskas
- Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Linas Šumskas
- Department of Preventive Medicine, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Institute of Health Research, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
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Pegum N, Connor JP, Young RM, Feeney GF. Psychosocial functioning in patients with alcohol-related liver disease post liver transplantation. Addict Behav 2015; 45:70-3. [PMID: 25644590 DOI: 10.1016/j.addbeh.2015.01.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 12/29/2014] [Accepted: 01/12/2015] [Indexed: 12/20/2022]
Abstract
Emotional and role functioning difficulties are associated with chronic alcohol use and liver disease. Little is known about prospective changes in psychological and psychosocial functioning following orthotopic liver transplantation (OLT) amongst patients with alcoholic liver disease (ALD). We aimed to assess the functioning of this patient group post liver transplantation. Comprehensive psychosocial assessment of depression (Beck Depression Inventory [BDI]), anxiety (State-Trait Anxiety Inventory-Form X [STAI]) and psychosocial adjustment (Psychosocial Adjustment to Illness Scale-Self-Report version [PAIS-SR]) was conducted with 42 ALD patients available for pre and post OLT testing. Dependence severity was assessed by the Brief Michigan Alcoholism Screening Test (bMAST). Significant reductions in average anxiety and depression symptoms were observed 12-months post-OLT. Significant improvements in psychosocial adjustment to illness were also reported. Patients with higher levels of alcohol dependence severity pre transplant assessment improved comparably to those with lower levels of dependence. In summary, the study found that OLT contributed to reducing overall levels of mood and anxiety symptoms in ALD patients, approximating general (non-clinical) population norms. Psychosocial adjustment also improved significantly post liver transplantation.
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Sarkar M, Watt KD, Terrault N, Berenguer M. Outcomes in liver transplantation: does sex matter? J Hepatol 2015; 62:946-55. [PMID: 25433162 PMCID: PMC5935797 DOI: 10.1016/j.jhep.2014.11.023] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/05/2014] [Accepted: 11/16/2014] [Indexed: 02/06/2023]
Abstract
A growing literature has highlighted important differences in transplant-related outcomes between men and women. In the United States there are fewer women than men on the liver transplant waitlist and women are two times less likely to receive a deceased or living-related liver transplant. Sex-based differences exist not only in waitlist but also in post-transplant outcomes, particularly in some specific liver diseases, such as hepatitis C. In the era of individualized medicine, recognition of these differences in the approach to pre and post-liver transplant care may impact short and long-term outcomes.
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Affiliation(s)
- Monika Sarkar
- Division of Gastroenterology and Hepatology, University of California, San Francisco, 513 Parnassus Avenue, S-357, San Francisco, CA 94143, USA.
| | - Kymberly D Watt
- Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, 200 First St, Rochester, MN 55905, USA
| | - Norah Terrault
- Division of Gastroenterology and Hepatology, University of California, San Francisco, 513 Parnassus Avenue, S-357, San Francisco, CA 94143, USA
| | - Marina Berenguer
- Hepatology and Liver Transplantation Unit, La Fe Hospital and Ciberehd, Universidad Valencia, C/Bulevar Sur sn (Torre F-5) 46026 Valencia, Spain
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Factors affecting health-related quality of life and physical activity after liver transplantation for autoimmune and nonautoimmune liver diseases: a prospective, single centre study. J Immunol Res 2014; 2014:738297. [PMID: 24741621 PMCID: PMC3987938 DOI: 10.1155/2014/738297] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 01/11/2014] [Indexed: 01/11/2023] Open
Abstract
Background/Aim. With the improvement of the outcomes after liver transplantation (LTx), health-related quality of life (HRQoL) and physical activity are becoming significant outcome parameters. We prospectively assessed these parameters in patients with autoimmune and nonautoimmune liver disorders undergoing LTx. Materials and Methods. Patients (n = 107) were subdivided into 3 groups depending on the time after LTx: group-A (n = 21): 6–12 months; group-B (n = 48): 13–36 months; and group-C (n = 38): >37 months. SF-36 and IPAQ were applied in HRQoL and physical activity assessment. Results. Females had impaired HRQoL in most SF-36 domains. Younger patients showed higher scores at SF-36 physical functioning domain but IPAQ was not influenced by age. Group-B had higher general health and physical component summary than group-A (P = 0.037, P = 0.04, resp.) and total IPAQ than group-C (P = 0.047). The sitting time domain was longer in group-A than in group-B and group-C (P = 0.0157; P = 0.042, resp.). Employed patients had better HRQoL and higher physical activity than those not working. SF-36 and IPAQ were unrelated to the autoimmune etiology of liver disease. Conclusions. These findings show that female and unemployed patients have worse HRQoL, while gender and age at LTx time do not affect IPAQ's physical activity. The autoimmune etiology of liver disease does not influence HRQoL and physical activity after LTx.
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Weng LC, Huang HL, Wang YW, Lee WC, Chen KH, Yang TY. The effect of self-efficacy, depression and symptom distress on employment status and leisure activities of liver transplant recipients. J Adv Nurs 2013; 70:1573-83. [PMID: 24237349 DOI: 10.1111/jan.12315] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2013] [Indexed: 01/01/2023]
Abstract
AIM To examine the effect of self-efficacy, subjective work ability, depression and symptom distress on and to provide a description of, the employment and leisure activities of liver transplant recipients. BACKGROUND Return to work and leisure activities have become an important aspect of life for liver transplant recipients worldwide. An investigation of the factors that influence the employment status and leisure activities has been recommended as a means to help transplant recipients restore their productivity. DESIGN This was a cross-sectional, descriptive and correlational study in 2010. METHODS A convenience sampling method was used. Data were collected using a set of questionnaires that were administered retrospectively. A total of 106 liver transplant patients were included in this study. RESULTS The post-transplantation employment rate was 45.2%. The positive predictors of employment were higher subjective work ability and higher symptom distress. Gender (female), monthly family income (<US $2,000), depression and unemployment pre-transplantation were negatively associated with employment status. Of the 106 patients, 62 (58.5%) were in the low-diversity group (score of less than 3) of leisure activities. Monthly family income of <US $2,000 was associated with a low diversity of participation in leisure activities. CONCLUSION Subjective work ability and symptom distress were positive predictors of employment, while depression was a negative predictor. Nurses in the transplant team should focus on increasing a sense of confidence, decreasing depressive symptoms and monitoring the severity of symptoms to improve the employment status of liver transplant recipients.
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Affiliation(s)
- Li-Chueh Weng
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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24
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Burra P, Germani G. Long-term quality of life for transplant recipients. Liver Transpl 2013; 19 Suppl 2:S40-3. [PMID: 23960031 DOI: 10.1002/lt.23725] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 08/08/2013] [Indexed: 02/06/2023]
Affiliation(s)
- Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy
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25
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26
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Huda A, Newcomer R, Harrington C, Blegen MG, Keeffe EB. High rate of unemployment after liver transplantation: analysis of the United Network for Organ Sharing database. Liver Transpl 2012; 18:89-99. [PMID: 21837745 DOI: 10.1002/lt.22408] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The goal of liver transplantation (LT) is to maximize the length and quality of a patient's life and facilitate his or her return to full productivity. The aims of this study were (1) to use the United Network for Organ Sharing (UNOS) data set to determine the proportions of recipients who were employed and unemployed within 24 months after LT between 2002 and 2008 and (2) to examine the factors associated with a return to employment. UNOS data that were collected since the adoption of the Model for End-Stage Liver Disease scoring system on February 27, 2002 were analyzed. There were 21,942 transplant recipients who met the inclusion criteria. The employment status of the recipients was analyzed within a 60-day window at the following times after transplantation: 6, 12, and 24 months. Approximately one-quarter of the LT recipients (5360 or 24.4%) were employed within 24 months after transplantation, and the remaining recipients had not returned to work. The demographic variables that were independently associated with posttransplant employment included an age of 18 to 40 years, male sex, a college degree, Caucasian race, and pretransplant employment. Patients with alcoholic liver disease had a significantly lower rate of employment than patients with other etiologies of liver disease. The recipients who were employed after transplantation had significantly better functional status than those who were not employed. In conclusion, the employment rate after LT is low, with only one-quarter of LT recipients employed. New national and individual transplant program policies are needed to assess the root causes of unemployment in recipients who wish to work after LT.
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Affiliation(s)
- Amina Huda
- Liver Transplant Program, Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, 750 Welch Road, Stanford, CA 94304, USA.
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Abstract
The purpose of the present study was to assess quality of life (QoL) in Brazilian women living with HIV/AIDS, according to the World Health Organization Quality of Life HIV-BREF (WHOQoL-HIV-BREF) domains. A quantitative-based, cross-sectional, analytical study was carried out in healthcare centers specialized in assisting people living with HIV/AIDS, located in a municipality of the state of São Paulo, Brazil. One hundred and six women of age 18 years or more, users of the public healthcare system, participated in the study. Socio-demographic and clinical variables were collected using a specific questionnaire. Quality of life related variables were collected by means of the WHOQoL-HIV-BREF instrument. As per the QoL domains, study results show that the Spirituality domain reached a standardized mean score of 65.7, followed by the Physical (64.7), Psychological (60.6), Social Relationships (59.5), Independence (58.6), and Environment (54.5) domains. Results of the multiple regression analysis indicate that the women's employment or retirement, income greater than the minimum wage, and higher educational level were associated with a higher standardized mean score of QoL. However, recent HIV/AIDS diagnosis and exposure to antiretroviral agents for a period shorter than two years were negatively associated with QoL. It is critical that public policies favor an all-embracing social inclusion of these women, thus promoting better social conditions. Counseling, clinical follow-up immediately after the infection diagnosis, and initiation of antiretroviral treatment are crucial moments in the lives of these individuals.
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Carbone M, Neuberger J. Liver transplantation for hepatitis C and alcoholic liver disease. J Transplant 2010; 2010:893893. [PMID: 21209701 PMCID: PMC3010646 DOI: 10.1155/2010/893893] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 11/16/2010] [Indexed: 02/08/2023] Open
Abstract
End-stage liver disease due to hepatitis C (HCV) and cirrhosis from alcohol (ALD) are the commonest indications for liver transplantation in the western countries. Up to one third of HCV-infected transplant candidates have a history of significant alcohol intake prior to transplantation. However, there are few data available about the possible interaction between alcohol and HCV in the post-transplant setting. Patients with both HCV and alcohol are more likely to die on the waiting list than those with ALD and HCV alone. However, after transplantation, non-risk adjusted graft and patient survival of patients with HCV + ALD are comparable to those of patients with HCV cirrhosis or ALD cirrhosis alone. In the short and medium term HCV recurrence after transplant in patients with HCV + ALD cirrhosis does not seem more aggressive than that in patients with HCV cirrhosis alone. A relapse in alcohol consumption in patients with HCV + ALD cirrhosis does not have a major impact on graft survival. The evidence shows that, as is currently practiced, HCV + ALD as an appropriate indication for liver transplantation. However, these data are based on retrospective analyses with relatively short follow-up so the conclusions must be treated with caution.
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Affiliation(s)
- Marco Carbone
- Liver Unit, Queen Elizabeth Hospital, Birmingham B152TH, UK
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Bownik H, Saab S. The effects of hepatitis C recurrence on health-related quality of life in liver transplant recipients. Liver Int 2010; 30:19-30. [PMID: 19845850 DOI: 10.1111/j.1478-3231.2009.02152.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Orthotopic liver transplantation (OLT) remains the definitive treatment for hepatitis C (HCV). Although HCV is the number one indication for OLT in the USA, health-related quality of life (HRQOL) scores are consistently lower for HCV patients when compared with all OLT indications. HCV is unique in that 95% of transplanted patients experience virological recurrence of HCV hepatitis. Despite few physical manifestations of disease at the time of HCV recurrence, patients report an impaired quality of life and functional status compared with OLT recipients without recurrence. Studies show that patient knowledge of the diagnosis of recurrent HCV alone can negatively impact HRQOL. This suggests that patients perceive themselves as unwell and have significant changes in their mental and physical health despite the absence of disease-related complications. Multiple studies show that patients with HCV recurrence report significantly higher scores for depression, anxiety and psychological distress. However, only a limited number of studies have investigated the influence of gender, HCV genotype, or HCV antiviral treatment on the HRQOL of OLT recipients with HCV recurrence. This review article describes what is currently known about the impact of recurrent HCV on HRQOL specifically after OLT. Understanding modifiable factors on HRQOL after HCV recurrence in OLT patients can greatly aid in tailoring multidimensional interventions to improve patient HRQOL.
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Affiliation(s)
- Hillary Bownik
- Department of Medicine, University of California, Los Angeles, CA 90095, USA
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30
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Abstract
With improvements in patient and graft survival after liver transplantation, recipient quality of life (QOL) has become an important focus of patient care and clinical outcomes research. To provide a better understanding of the instruments used to assess QOL in the adult liver transplant population, we conducted a systematic review of the MEDLINE database and Cochrane library. Our review identified 128 relevant articles utilizing more than 50 different QOL instruments. Generic health status instruments are the most commonly used, and among them the Medical Outcomes Study Short Form-36 (SF-36), the Hospital Anxiety and Depression Scale (HADS), and the Beck Depression Inventory (BDI) are the most prevalent. Few studies (16%) included targeted, disease-specific instruments. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Quality of Life questionnaire, the Liver Disease Quality of Life questionnaire, and the Chronic Liver Disease questionnaire are the most frequently employed targeted instruments; however, these instruments have been designed to assess QOL in patients with chronic liver disease rather than patients after liver transplantation. The present review focuses on the psychometric properties of the existing QOL instruments and discusses their individual strengths and limitations in evaluating liver transplantation recipients. The lack of a gold-standard QOL instrument for liver transplant recipients is an impediment to cross-study comparisons. We conclude that the development of a QOL instrument specifically for liver transplant recipients will improve QOL assessment in this population leading to a more nuanced understanding of the factors that influence transplant recipients' well-being.
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Affiliation(s)
- Colleen L. Jay
- Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL 60611, USA
| | - Zeeshan Butt
- Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL 60611, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniela P. Ladner
- Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL 60611, USA
| | - Anton I. Skaro
- Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL 60611, USA
| | - Michael M. Abecassis
- Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL 60611, USA
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Aberg F, Rissanen AM, Sintonen H, Roine RP, Höckerstedt K, Isoniemi H. Health-related quality of life and employment status of liver transplant patients. Liver Transpl 2009; 15:64-72. [PMID: 19109833 DOI: 10.1002/lt.21651] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Health-related quality of life (HRQoL) is one preferable outcome measure of medical interventions such as liver transplantation (LT). The aim of this study was to compare HRQoL of LT patients with that of the general population and to assess the employment status of LT patients. HRQoL was measured with the 15D instrument, a validated, non-disease-specific, 15-dimensional, self-administered HRQoL instrument. The questionnaire was sent to all adult LT patients in Finland (401 patients) alive in June 2007. The response rate was 89% (353 patients). The results were compared to those of 6050 age-standardized and gender-standardized controls from the general population. LT patients (mean age, 55 years; range, 20-82) had slightly worse HRQoL scores than the general population (mean 15D score, 0.889 versus 0.907; P < 0.002). Survival time and retransplantation did not affect HRQoL significantly in age-adjusted and gender-adjusted analyses. HRQoL decreased with increasing age (P < 0.0001). Patients transplanted for acute liver failure (ALF) or chronic liver disease (CLD) had significantly worse HRQoL than the general population (P = 0.014 and P = 0.040). Forty-four percent of working-age patients were employed at the time of the study. Persons that were employed had significantly better HRQoL than those unemployed (15D scores, 0.934 versus 0.859; P < 0.0001). Eighty-seven percent of patients experienced improved working capacity after LT. Early retirement was the most common cause of unemployment (56% of unemployed patients), and those patients presented with worse HRQoL than patients unemployed for other reasons. In conclusion, HRQoL of LT patients is very close to that of the general population. Older age, CLD, and ALF impair HRQoL. Employment is an indicator of HRQoL.
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Affiliation(s)
- Fredrik Aberg
- Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki, Finland.
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Desai R, Jamieson NV, Gimson AE, Watson CJ, Gibbs P, Bradley JA, Praseedom RK. Quality of life up to 30 years following liver transplantation. Liver Transpl 2008; 14:1473-9. [PMID: 18825684 DOI: 10.1002/lt.21561] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Liver transplantation provides a return to a satisfactory quality of life (QOL) for the majority of patients in the short to medium term (first 5 years), but there is very little information on the QOL in the longer term and the factors influencing it. We therefore undertook a single-center cross-sectional analysis to determine QOL in patients 10 or more years after liver transplantation. All liver transplant recipients who were followed up at the Cambridge Transplant Unit for 10 or more years (transplanted between 1968 and 1994) and resident in the United Kingdom were asked to complete by post the Short Form 36 version 2 and the Ferrans and Powers questionnaires to evaluate their QOL. Univariate and multivariate analysis were performed to assess the relationship between a range of clinical parameters and QOL. One hundred two patients were invited to participate, and 61 (59.8%) responded. Overall, the patients reported a satisfactory QOL. On the Ferrans and Powers questionnaire, the patients had a mean Quality of Life Index score of 24.5. Factors associated with reduced physical functioning were age > 50 years at transplantation, female gender, and recurrence of the primary liver disease. On the Short Form 36 version 2 questionnaire, recipients had reduced physical functioning but normal mental health parameters in comparison with the normal population. Age > 60 years at the time of survey, female gender, and posttransplant complications were associated with reduced physical functioning. In conclusion, patients 10 or more years after liver transplantation generally have a good QOL, although physical functioning is reduced. Addressing issues such as recurrent disease and posttransplant problems such as osteoporosis may help to improve long-term QOL.
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Affiliation(s)
- Rajendra Desai
- National Institute for Health Research Comprehensive Biomedical Research Centre, Cambridge University Hospitals National Health Service Foundation Trust, Addenbrooke's Hospital, Cambridge, England.
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33
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Quality of life after liver transplantation. A systematic review. J Hepatol 2008; 48:567-77. [PMID: 18279999 DOI: 10.1016/j.jhep.2007.12.013] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Accepted: 12/19/2007] [Indexed: 12/15/2022]
Abstract
BACKGROUND/AIMS Although many studies have reported significant improvements in quality of life (QOL) after liver transplantation (LT), consistent data on areas of improvement are lacking. To perform a systematic review on medical literature of QOL after LT paying particular attention to studies that utilized the most commonly adopted study instrument, Short Form-36 (SF-36). METHODS To collect studies focused on QOL in adult LT recipients, from 1963 to 2007, cited in Pub Med, Embase or Cochrane databases. From an initial identification of 613 articles, we selected 44 longitudinal studies with pre- and post-LT data that we assessed using a sign test, and 19 used SF-36, which we analyzed separately. RESULTS Longitudinal data showed remarkable improvement of common domains of QOL comparing pre- and post-transplant items. However, analysis of 16 SF-36 cross-sectional studies comparing post-LT patient domains with control population showed significantly higher ratings for controls in six while no differences were found in two. CONCLUSIONS This review suggests that whereas general QOL improves after LT, when compared with healthy controls, LT recipients have significant deficits in QOL. Consequently, the previously reported QOL benefits after LT may have been overstated.
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Ortega F, Valdés C, Ortega T. Quality of life after solid organ transplantation. Transplant Rev (Orlando) 2007. [DOI: 10.1016/j.trre.2007.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Cleemput I, Dobbels F. Measuring patient-reported outcomes in solid organ transplant recipients: an overview of instruments developed to date. PHARMACOECONOMICS 2007; 25:269-86. [PMID: 17402802 DOI: 10.2165/00019053-200725040-00002] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Improvements in organ preservation methods, immunosuppressive regimens and general post-transplant care have resulted in an increased life expectancy and a continually decreasing morbidity after solid organ transplantation. As attention gradually moves towards improving subjective patient outcomes, the use of patient-reported outcome measures (PROs) thus becomes increasingly important in post-transplant patient management. This paper provides a brief systematic overview of the transplant-specific PRO measures, and their psychometric properties, developed and used in solid organ transplant recipients to date. PRO measures may focus on or encompass different aspects of life relevant to organ transplant patients: overall quality of life (QOL), physical, psychological and social functioning, and adherence. Overall QOL can be measured using transplant-specific or generic QOL instruments, or a combination of both. In general, very little information is available on the psychometric properties of PRO measures, and there is no gold standard for PRO measurement. Transplant-specific and generic PRO instruments are complementary. Generic instruments will continue to be important for economic evaluations, but transplant-specific instruments may be more useful for patient management purposes, as they are generally more sensitive to small but clinically relevant changes in outcomes in transplant populations.
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Affiliation(s)
- Irina Cleemput
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium.
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36
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Abstract
A number of different studies have shown a clear reduction in the quality of life of hepatitis C virus (HCV)-related liver-disease patients. Quality of life can be assessed by means of both generic and specific instruments, depending on the aim of the study and the population being studied. The application of a specific instrument to patients with liver diseases provides a broader assessment of different parameters related to hepatic disorders. In hepatitis C, alterations such as the stigma of liver disease, concerns about the disease and symptoms of the disease could be demonstrated with this type of instrument. The impact of the diagnosis of hepatitis C, a potentially serious disease, and the presence of comorbidities such as alcohol and drugs may lead to lower quality of life. Longitudinal studies have proved that, following diagnosis, the stigma of liver disease becomes more apparent over time. Women report worse quality of life than men, supporting that gender differences in hepatitis are also important when assessing quality of life. Alterations in the quality of life of patients submitted to treatment are mainly related to the somatic side effects of Interferon and Ribavirin and are most noticeable in the first weeks of therapy. Early improvement in the quality of life of patients who become HCV-RNA negative suggests that the virus itself plays a biological role. There is no doubt that liver transplantation leads to an improvement in quality of life. Nevertheless, a major concern is the relapse of HCV, with the associated lower quality of life.
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Affiliation(s)
- Edna Strauss
- Department of Pathology, School of Medicine, University of São Paulo, SP, Brazil.
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37
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Dan AA, Younossi ZM. Quality of life and liver transplantation in patients with polycystic liver disease. Liver Transpl 2006; 12:1184-5. [PMID: 16868956 DOI: 10.1002/lt.20796] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Krasnoff JB, Vintro AQ, Ascher NL, Bass NM, Paul SM, Dodd MJ, Painter PL. A randomized trial of exercise and dietary counseling after liver transplantation. Am J Transplant 2006; 6:1896-905. [PMID: 16889545 DOI: 10.1111/j.1600-6143.2006.01391.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We report results of a randomized clinical trial of a combined intervention of exercise and dietary counseling (ExD) after orthotopic liver transplantation (OLT). Of the 151 patients randomized into ExD or usual care (UC), 119 completed testing 2, 6 and 12 months post-OLT. Testing included assessment of exercise capacity (VO(2peak)), quadricep muscle strength, body composition (DXA), nutritional intake (Block 95) and health-related quality of life (SF-36). The intervention consisted of individualized counseling and follow-up to home-based exercise and dietary modification. Repeated measure ANOVA was performed to determine differences over time between ExD and UC with a secondary analysis to determine differences over time between adherers (Adh), nonadherers (Nadh) to the intervention and UC. The ExD group showed greater increases in VO(2peak) (p = 0.036), and self-reported general health (p = 0.038) compared to UC. Both groups demonstrated increases in muscle strength, body weight, body fat and other SF-36 scale scores. Adherence to the intervention was 37% with positive trends in VO(2peak) and body composition observed in Adh compared to Nadh and UC. These data suggest improvements in exercise capacity and body composition are achieved with nutrition and exercise behavior modifications initiated early after OLT and with regular follow-up.
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Affiliation(s)
- J B Krasnoff
- Department of Physiological Nursing, University of California, San Francisco, USA.
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39
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40
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Krasnoff JB, Vintro AQ, Ascher NL, Bass NM, Dodd MJ, Painter PL. Objective measures of health-related quality of life over 24 months post-liver transplantation. Clin Transplant 2005; 19:1-9. [PMID: 15659126 DOI: 10.1111/j.1399-0012.2004.00306.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Many studies have reported improved health-related quality of life (HRQoL) from pre- to immediate post-orthotopic liver transplantation (OLT). However, few studies have evaluated longitudinal changes over the first 2 yr post-OLT and none have simultaneously examined objective measures of health-related fitness. A total of 50 OLT recipients (32 males,18 females; 51.4 +/- 11.8 yr) completed testing at 2, 6, 12, and 24 months post-OLT. Testing included assessment of exercise capacity (peak VO2), quadriceps muscle strength, body composition, physical activity participation, and self-reported functioning (SF-36). Repeated measures of analysis of variance (ANOVA) with post hoc contrasts was performed to determine differences over time and a second ANOVA assessed differences over time between genders. All patients increased peak VO2, quadriceps muscle strength, and percent body fat (p < 0.0001) from 2 to 24 months. Men and women differed in their changes of peak VO2 and percent body fat (p < 0.05). At 24 months, only 50% of the patients reported participating in regular physical activity. All SF-36 physical measures except general health, improved from 2 to 24 months (p < 0.0001). Measures of health-related fitness and QoL improve over the first 2 yr post-OLT with the greatest gains occurring in the first 6 months and all measures remain lower than recommended for cardiovascular and overall health. A randomized clinical trial of lifestyle modifications such as diet and exercise intervention is warranted to determine the impact of such modifications on HRQoL and fitness post-OLT.
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Affiliation(s)
- Joanne B Krasnoff
- Department of Physiological Nursing, University of California San Francisco, San Francisco, CA 941430-0610, USA.
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